Dr., Ms., Mr.  * ? Dr. Ms. Mr.

*First Name    

*Last Name    

*Title               

*Address        (note-this address will appear in the conference notebook)

Address        
(Continued)

*City                   * State/Province    * Zip/Postal Code  

*Representing  

*Day Phone        Home Phone  (for FCLB use only - not distributed)

*Fax                                  *Email 

Guest 1                Guest 2  
(Please enter guest names EXACTLY as they should appear on the guest name badge)

*Have you previously attended an FCLB Conference? ? Yes No

*Registration Status  ? Voting Delegate Alternate Delegate Other

Wednesday, May 5:
 * ? Yes No PACE Overview - CE Provider Approval: 9:30 AM - Noon

 * ? Yes No FCLB Committee Meetings: 1:00 PM - 3:00 PM

 * ? Yes No ACBA Board Administrator's Meeting: All Day - Includes Lunch

Thursday, May 6:
 * ? Yes No New Attendee Breakfast - 7:30 -8:30 AM

 * ? Yes No CCE Site Team Academy Orientation & Training: 1:30 - 5:30 PM

Friday, May 7:
* ? Yes No   Family Fun at "The Flags": 6:00 PM join us for an indoor, all-you-can-eat
                 old fashioned picnic and regulatory "family reunion" at Denver's famous
                 Six Flags Elitch Gardens Amusement Park.

Tour of NBCE/FCLB Greeley Executive Offices
(free - transportation provided - about an hour away from the Westin Hotel)

Yes - I’d like to go!  Check your preference:
           Thursday, May 6  2:00 - 5:30 PM
           Saturday, May 8  2:00 - 5:30 PM
           Either date works for me
      Number attending including my guest(s)
No, I don't plan to go

Spouse/Guest: Will you participate in any of the activities?

Thursday, May 6

* ? Yes No Denver Mountain Parks Tour: 9:00 AM - 1:00 PM - join us on a tour of our Denver Mountain Parks.
                See the location of the Denver Federal Center, visit Red Rocks Amphitheater, enjoy the vista on top of
                Lookout Mountain where we'll provide a snack on the mountain-top, then browse through the Buffalo
                Bill Museum and see his final resting place, and enjoy a trip through Golden's historical downtown.

Cost is $30 per person          *Number of Guests
(Payment is preferred before Denver arrival)

Friday, May 7

* ? Yes No Family Fun at "The Flags": 6:00 PM

Cost is $50 per person           *Number of Guests
(Payment is preferred before Denver arrival)

Additional Amenities:

Conference T-Shirts

Short-sleeved Hanes Beefy T-shirts with conference logo

          $10 each - advance order only!

* ? Yes No Would like to order conference T-Shirts?         Sizes  # MED  # LG

                                                                                                           # XL       # XXL

Payment Information

Conference Fees		Deadline
$375	Early Bird Registration	3/25/04
$395	On-Time Registration	4/14/04
$425	Late Registration	4/15/04 and After

     Registration fee to be paid by * ? Attendee Licensing Board/Other Organization Attendee and Board/Organization  

                                                                  Please Specify Board or Organization  

      Amount to be paid by attendee                     

                            Form of Payment   Check Money Order Master Card Visa Cash    

Amount to be paid by Board or Organization 

Travel Plans (Note: This helps both the FCLB and the Hotel plan for you)

        Arrival Date         Approx. Arrival Time

  Departure Date    Approx. Departure Time

 Travel or other information you would like FCLB Staff to know.
 

Special Accommodations

Are there any special accommodations you need to make your (or your guest's) conference experience more comfortable?
 (i.e., hearing assistance, accessibility, diet considerations) 

Stop!

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